Image by Oliver Kepka
We live in an age in which we could theoretically live our lives without the need to leave the house or see another person for days, weeks, months on end. The Japanese have a name – hikikomori – for teenagers or young adults who live as modern-day hermits, refusing to leave their houses for months or even years.
We can do our shopping online, manage our bank accounts electronically, and run a business from a virtual office. If we want to learn a new skill – be it a craft, a language, or even meditation or yoga – DVDs, Apps and the Internet enable us to do so from our own homes. And if this isolation were to cause depression or anxiety, fear not! We can have a self-help book delivered to our door at the click of a button, and follow each step in its pages without anyone else intervening. But sometimes we find ourselves unable to bring about the changes we desire even when we want to.
It would be easy to think that when we fail, it’s simply because we didn’t try hard enough. Perhaps we lacked willpower or self-discipline, or simply felt halfhearted. We may locate the blame entirely in ourselves; we may think that we personally lack what it takes for success. However, perhaps what we are actually lacking is the relational component.
It is a common experience that it is much easier to achieve change when we have a supportive relationship with another person (or a group) who understands, inspires and encourages us – this experience forms the bedrock of myriad group interventions, from Weight Watchers to Alcoholic Anonymous. Despite the strongly individualistic nature of Western society, there is only so much that we can achieve on our own. Perhaps this is also true of personal change.
Does Therapy Work?
There is considerable evidence that therapy works. In the UK the National Institute of Health and Care Excellence (NICE) provides specific guidelines as to which particular approaches a therapist should consider using according to a patient’s psychiatric diagnosis. The treatments NICE recommends are ‘evidence-based’, which means that studies have indicated they are an effective intervention for a particular problem. For example, Mindfulness-Based Cognitive Therapy (MBCT) is a recommended relapse-prevention intervention for recurrent depression – and is widely seen as the current treatment of choice. However, many psychologists argue that the evidence in support of ‘one issue, one therapy’ simply doesn’t stack up.
Psychologist Scott Miller states that there is a lack of evidence that the diagnosis a person receives is correlated with the outcome, much less that it informs us which particular treatment approach is best. Along with many others, Miller believes that the field of psychology is so caught up in the notion of evidence-based practice, with its focus on technique, that we dismiss the most crucial influence – that of the therapists themselves.
If the therapeutic alliance is a key predictor of successful outcome, finding the right therapist, rather than the right therapy, may be best for encouraging personal change.
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In 1974, US researcher David Ricks coined the term ‘supershrinks’ to describe a category of exceptional therapists. Ricks’s research investigated the long-term outcomes of ‘highly disturbed’ adolescent boys. When his participants were re-examined as adults, he discovered that a select group, who had been treated by one particular provider, had notably better outcomes.
In contrast those who had been treated by the ‘pseudoshrink’ demonstrated very poor adjustment as adult men. His conclusion – that therapists differ in their ability to affect change in their clients – is not exactly revelatory, but what is surprising is how much this finding has been overlooked in favour of trying to determine what therapies are most effective.
More recent research has confirmed that some therapists achieve better outcomes with their patients than others. A 2005 study by psychologists Bruce Wampold and Jeb Brown involved 581 licensed therapy providers (including psychologists, psychiatrists and masters-level therapists) who were treating a diverse sample of more than 6,000 people.
The researchers found that the clients’ age, gender and diagnosis had no impact on the success rate of the treatment, nor did the experience, theoretical orientation or training of the therapists. What they did find was that the clients treated by the best therapists in the sample improved at a rate at least 50 per cent faster than those treated by the worst. Miller and colleagues have pointed to this and other studies as ‘incontrovertible’ evidence for their position that ‘who provides the therapy is a much more important determinant of success than what treatment approach is provided.
It would be easy to assume a ‘supershrink’ would be someone very experienced – perhaps someone with ‘consultant’ in their title, or a full head of grey hair. But years in the job doesn’t guarantee increased psychological knowledge, or therapeutic expertise and competence. In fact one study found that trainee clinical psychologists outperformed experienced therapists on psychological knowledge and skills. So, simply accruing years of experience is probably not enough to turn an average therapist into a supershrink.
What Is The Secret of a Therapist's Success?
So what is the secret of supershrinks’ success? What sets them apart from average therapists? This was the question that Miller, together with fellow psychologists Mark Hubble and Barry Duncan, set out to answer in the early 2000s. In an article detailing their quest, they reveal that finding that answer turned out to be harder than they anticipated: the best therapists in their studies varied considerably in terms of their personal characteristics, their approach and their technical prowess. Nothing tangible seemed to separate ‘the best from the rest’ – was it simply a matter of chance?
Then one day Miller came across an article written about the research of Swedish psychologist K. Anders Ericsson – widely considered to be the ‘expert on experts’ – entitled ‘What It Takes to Be Great.’ The subtitle was even more intriguing: ‘Research now shows that the lack of natural talent is irrelevant to great success.’
Having spent nearly twenty years studying the world’s best musicians, chess players, teachers, athletes, and so on, Ericsson believed that greatness was not attributable to genetic endowment. ‘Systematic laboratory research,’ he writes, ‘provides no evidence for giftedness or innate talent.’ Rather, the key to superior performance is very simple: those who are the best at something simply work harder at getting better at it than others do. This is rather intuitive – like the saying ‘practise makes perfect’ – but, importantly, what Ericsson is referring to is deliberate practice. So it isn’t enough to just spend a lot of time doing something; it’s about the amount of time specifically dedicated to striving for objectives, or performance targets, just beyond your current level of proficiency.
According to Ericsson those who are the best at what they do are also attentive to feedback – which, he argues, is the crucial element that separates the best from the rest. Studies of physicians, for example, show that the most proficient at diagnosing medical problems tend to be the ones who follow up, who make the effort to find out whether they were right or wrong in their patient assessment. Ericsson claims that this extra step – seeking feedback – gives a significant advantage in that it enables us to better understand how and when we improve. Those who are the best at what they do maximize their opportunities to gain feedback – and aim to learn from it.
After reading Ericsson’s article, Miller and his colleagues were inspired to continue their efforts to understand how some therapists become better than others. What was the key to the superior performance of the supershrinks? Just as Ericsson had observed in champion chess players and Olympic athletes, Miller, Hubble and Duncan found that the best therapists work harder at improving their performance and, crucially, are consistently attentive to client feedback about how their clients feel about them and the work they are doing together.
So, we have some idea of what the best therapists do that helps them to improve and also of what we can do ourselves if we want to become better at something. It’s not enough to just work hard; gaining constructive feedback from others – something outside our own subjective appraisal of ourselves – also appears to be crucial. And maybe that’s something therapy does have over meditation; the feedback of the ‘biased observer’ might just be the very thing that gives us the edge in our quest to understand and improve ourselves.
To Sit and To Speak?
Change is an unpredictable and difficult game. If we want to boost our chances of success, we need to find someone to support us through the process – someone whom we can trust and who can help us believe that change can actually happen. While the therapeutic alliance may be more important than the particular technique, the type of therapy that we undergo is still worth our consideration. What will be a good match for our own values, beliefs and goals?
Many people may prefer – or require – the in-depth self-exploration and development of a bond with a therapist that individual therapy can provide, in which case attending an MBCT (Mindfulness-Based Cognitive Therapy) or MBSR (Mindfulness-Based Stress Reduction) group programme is unlikely to hit the spot. However, if you are someone with a spiritual worldview, it may well be that a mindfulness-based approach will particularly appeal to you – and this itself may increase your commitment to the change you’re trying to make.
Meditation and therapy might seem like an unlikely marriage, but integration of ancient techniques into modern interventions could be the way forwards. Can a shift in how we view our thoughts be a key to shifting our lives?
The introduction of Buddhist meditation into modern therapy is arguably revolutionary. The principle is simple enough: you will start to change once you experience your daily flow of thoughts and feelings in a very different way. Recent research on the use of mindfulness meditation (for example, for recurrent depression) suggests this is a real possibility.
Copyright 2015 and 2019 by Miguel Farias and Catherine Wikholm.
Published by Watkins, an imprint of Watkins Media Limited.
All Rights Reserved. www.watkinspublishing.com
The Buddha Pill: Can Meditation Change You?
by Dr Miguel Farias and Dr Catherine Wikholm
In The Buddha Pill, pioneering psychologists Dr Miguel Farias and Catherine Wikholm put meditation and mindfulness under the microscope. Separating fact from fiction, they reveal what scientific research – including their groundbreaking study on yoga and meditation with prisoners – tells us about the benefits and limitations of these techniques for improving our lives. As well as illuminating the potential, the authors argue that these practices may have unexpected consequences, and that peace and happiness may not always be the end result.
About the Authors
Dr Miguel Farias has pioneered brain research on the pain alleviating effects of spirituality and the psychological benefits of yoga and meditation. He was educated in Macao, Lisbon and Oxford. Following his doctorate, he was a researcher at the Oxford Centre for the Science of Mind and a lecturer at the Department of Experimental Psychology, University of Oxford. He currently leads the Brain, Belief and Behaviour group at the Centre for Research in Psychology, Behaviour and Achievement, Coventry University. Find out more about him at: http://miguelfarias.co.uk/
Catherine Wikholm read Philosophy and Theology at Oxford University before going on to do a Masters in Forensic Psychology. Her strong interest in personal change and prisoner rehabilitation led her to be employed by HM Prison Service, where she worked with young offenders. She has since been working in NHS mental health services and is currently completing a practitioner doctorate in Clinical Psychology at the University of Surrey. Miguel and Catherine worked together on a ground-breaking research study investigating the psychological effects of yoga and meditation in prisoners. Find out more at www.catherinewikholm.com